Articulated Dump Truck Proposals 12 04 2018
BID FORM ARTICULATED DUMP TRUCK LEASE Santa Rosa County Environmental Department 6051 Old Bagdad Highway Suite 301 Milton, Florida 32583 Date: A/4,v. 8, 2018 Dear Sir: The undersigned agrees to furnish the item as requested by you for Santa Rosa County in your Request for Proposal and certifies that the equipment meets or exceeds the specifications called for, except as set out in "Exceptions and Conditions" and attached to this form. Make and Model of Equipment ~''/la,- 730C ~ .£,..-vc/4 Name & Address of Company -z.i~A?f2S"(JA '7ii.cfr2L~- :z:;,,e. 2~7£2 [ef. /J,:,eHtf Rel ,?,,,,tko~ EZ ..i3SSV 48 month/6000hr lease: Articulated DUMP TRUCK $ 1, 87J. •!J, month .z I 4-.( &,,. &1dd Company Representativ~=tS!gnature 8£()- a,s-. atJ~6 Telephone EXCEPTIONS AND CONDITIONS: coMMENTs: Wz,1ew1i; ~✓'/,,~eds 5Peci f'tt:zlM$ .,,. ~tlt/~/.J f()UJt/t'/.et~J 6jdl,ut~s I &:.clu,~~JL ~l!)n,p<:>Aea.fs (ho~e~G-, ~eh, "' ptPtRh Ile-ti .S~/01<:<! bz~ I l,~e 1,,.[lel'!)c .,./ rl~ ~"'' a, ~~/'/Z~ l"t!pe:rr SWORN STATEMENT UNDER SECTION 287.133 (3) (A), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED IN THE PRESENCE OF I. 2. I understand that a "public entity crime" as defined in Paragraph 287 .133(l)(g). Florida Statutes means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods of services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitn1st, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
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